# Constipation — GCMD Library living collection

Everything in the library about constipation — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 54 cited statements

## Episodes
### Evidence & Research
- [Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263) — video · 1:09 · [machine version](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263.md)

### Case-Based Learning
- [The Colorectal Quiz Episode 8: Motility Disorders Part 1](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824) — podcast · 14:04 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824.md)
- [Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304) — podcast · 14:18 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=0) Introduction and Episode Setup (Ep 1)
- [1:31](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=91) Case Presentation and Expert Introductions (Ep 1)
- [2:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171) Defining Failure of Medical Management (Ep 1)
- [4:43](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=283) Initial Evaluation and Diagnostic Approach (Ep 1)
- [6:10](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=370) Contrast Enema Interpretation and Limitations (Ep 1)
- [8:45](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=525) Anorectal Manometry and Absent RAIR Finding (Ep 1)
- [11:20](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=680) Summary and Conclusion (Ep 1)
- [0:04](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=4) Introduction and recap of part one (Ep 2)
- [1:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=69) Appendix sharing and channel lengthening techniques (Ep 2)
- [4:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=278) Ambulatory status and surgical planning considerations (Ep 2)
- [7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=459) Orifice placement and operative sequencing (Ep 2)
- [11:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=669) Enema techniques for poor pelvic floor tone (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=0) Introduction (Ep 3)
- [0:12](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=12) Study Design (Ep 3)
- [0:29](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=29) Key Findings (Ep 3)
- [0:58](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=58) Conclusion and Call to Action (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining the relationship between delayed diagnosis of Hirschsprung disease and postoperative/functional outcomes." — Alex Halpern (clinical) [Ep 3 · 0:12](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=12)
- "The study included 679 patients with Hirschsprung disease from 14 different sites." — Alex Halpern (epidemiological) [Ep 3 · 0:23](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=23)
- "Increased age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure." — Alex Halpern (clinical) [Ep 3 · 0:29](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=29)
- "Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively." — Alex Halpern (clinical) [Ep 3 · 0:39](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=39)
- "No association was found between age at diagnosis and 30-day complication rate after initial pull-through." — Alex Halpern (clinical) [Ep 3 · 0:49](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=49)
- "No association was found between age at diagnosis and need for pull-through revision." — Alex Halpern (clinical) [Ep 3 · 0:49](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=49)
- "Delayed diagnosis of Hirschsprung disease affects certain postoperative and functional outcomes in patients." — Alex Halpern (clinical) [Ep 3 · 0:58](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=58)
- "Failure of medical management is defined as appropriate treatment with no appropriate response" — Kahleb Graham (clinical) [Ep 1 · 2:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171)
- "Patients who cannot take treatment (e.g., kids with autism or other cognitive problems) are considered to have failed medical management" — Kahleb Graham (clinical) [Ep 1 · 3:04](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=184)
- "Patients with persistent symptoms or pain with treatment, or failure to grow, are considered to have failed medical management" — Kahleb Graham (clinical) [Ep 1 · 3:04](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=184)
- "Failure of retrograde enemas is considered failure of medical management" — Kahleb Graham (clinical) [Ep 1 · 3:21](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=201)
- "Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management" — Anil Darbari (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=215)
- "General pediatricians typically prescribe osmotic laxatives (MiraLax, lactulose) and stimulant laxatives (Senna, bisacodyl), but there are other medications GI specialists use that pediatricians are not accustomed to prescribing" — Anil Darbari (clinical) [Ep 1 · 3:57](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=237)
- "Some children stool every day but don't completely evacuate" — Anil Darbari (clinical) [Ep 1 · 4:58](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=298)
- "Initial evaluation includes history (triggers, stooling frequency, sensation of complete emptying), physical exam (abdominal distension, palpable stool, rectal exam), and diagnostic imaging (abdominal X-ray, water-soluble contrast enema)" — Anil Darbari (clinical) [Ep 1 · 4:46](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=286)
- "In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step is diagnostic studies including contrast enema to assess colonic dilation, redundancy, and ensure normal ratio" — Kahleb Graham (clinical) [Ep 1 · 5:27](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=327)
- "Water-soluble contrast (not barium) is used for contrast enemas because it helps empty the colon and acts as a cleanout for patients starting new medical therapy" — Jason Frischer (clinical) [Ep 1 · 8:06](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=486)
- "Contrast studies are not great predictors of how patients will respond to medical or surgical management; normal-looking colons may not respond while abnormal-appearing colons may respond well" — Jason Frischer (clinical) [Ep 1 · 7:12](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=432)
- "The rectoanal inhibitory reflex (RAIR) is the response where the internal anal sphincter relaxes when the rectum becomes distended with stool" — Rod (host_summary) [Ep 1 · 9:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=551)
- "Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum" — Anil Darbari (clinical) [Ep 1 · 9:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=575)
- "High pressures on anorectal manometry may suggest underlying inability to relax, causing a functional obstruction" — Anil Darbari (clinical) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=600)
- "Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR)" — Anil Darbari (clinical) [Ep 1 · 10:09](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=609)
- "Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate, comparing sensation to defecate with internal anal sphincter response" — Anil Darbari (clinical) [Ep 1 · 10:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=619)
- "Doctor Levitt states he doesn't know how he survived without anorectal manometry testing" — Marc Levitt (opinion) [Ep 1 · 10:47](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=647)
- "In the past, surgeons did not understand the major role the sphincter played in many patients" — Jason Frischer (opinion) [Ep 1 · 10:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=651)
- "Colonic motility assessment is critical because in the past, colons or sigmoid colons were resected based on appearance, but patients had motility disorders and did not need resection" — Marc Levitt (clinical) [Ep 1 · 7:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=456)
- "Many dilated colons will respond to treatment" — Marc Levitt (clinical) [Ep 1 · 7:54](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=474)
- "Anorectal manometry is critical for determining whether a patient needs surgery or resection, as patients with motility disorders do not need surgery" — Rod (host_summary) [Ep 1 · 12:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=723)
- "When a 7 cm appendix is shared between urology and colorectal surgery, the urologist typically takes 6.25 cm leaving only 0.75 cm for colorectal use" — Jason Frischer (clinical) [Ep 2 · 1:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=77)
- "Urologists typically take a 70/30 split when sharing the appendix" — Marc Levitt (opinion) [Ep 2 · 1:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=98)
- "The colorectal team benefits from using the appendix portion closer to the cecum which has a stronger blood supply" — Jason Frischer (clinical) [Ep 2 · 1:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=115)
- "A short appendiceal stump can be extended by suturing or using a laparoscopic non-cutting linear stapler along the cecal wall to add 2-3 cm of length" — Jason Frischer (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=125)
- "One of the problems with Malone appendicostomy is leakage" — Jason Frischer (clinical) [Ep 2 · 2:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=154)
- "The longer the Malone channel, the less likely it is to leak" — Jason Frischer (clinical) [Ep 2 · 2:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=167)
- "Extending the Malone channel by 2-3 cm using suturing or stapling can be extremely helpful in preventing leakage" — Jason Frischer (clinical) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=175)
- "Children in rural locations or with behavioral issues who pull at tubes are good candidates for an unplicated Malone" (clinical) [Ep 2 · 3:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=182)
- "Rectal irrigation using pressurized water systems made for patients with hand difficulties is an alternative to Malone and Mitrofanoff procedures" — Jason Frischer (clinical) [Ep 2 · 3:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=223)
- "Coloplast makes a rectal irrigation device for self-administration of enemas" — Jason Frischer (clinical) [Ep 2 · 4:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=265)
- "Spinal patients with absent coccyx have difficulty retaining rectal enema fluid even for the short time from standing to reaching the toilet" — Wendy (clinical) [Ep 2 · 4:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=297)
- "Cecostomy or Malone routes allow spinal patients with mobility compromise to use a small floor potty rather than transferring to a toilet" — Wendy (clinical) [Ep 2 · 5:23](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=323)
- "Most spinal patients prefer not to have a stoma bag and prefer transferring to a commode for antegrade flush" — Marc Levitt (clinical) [Ep 2 · 5:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=345)
- "If the colon is very difficult to empty (requiring voluminous or concentrated enemas) and the urologist needs to do bladder augmentation, the sigmoid can be removed from colonic transit to make bowel management easier and used by the urologist for augmentation" — Marc Levitt (clinical) [Ep 2 · 6:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=398)
- "If the patient has an easy to empty colon, the colon can stay in and the urologist can use small bowel for augmentation" — Marc Levitt (clinical) [Ep 2 · 7:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=444)
- "Careful assessment of existing bowel management including sit time, ingredients, and flush volume is necessary before the next surgical intervention" (host_summary) [Ep 2 · 7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=459)
- "A good bowel management plan can influence the urologic surgical plan" — Marc Levitt (clinical) [Ep 2 · 7:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=472)
- "Once patients are emptying regularly for stool without impactions, their bladder may work better and reflux might resolve" — Marc Levitt (clinical) [Ep 2 · 7:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=478)
- "Successful bowel management might save a patient from needing ureteral reimplantation" — Marc Levitt (clinical) [Ep 2 · 8:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=489)
- "Urologists often request that bowel management work happen first before determining what bladder surgery is needed" — Marc Levitt (clinical) [Ep 2 · 8:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=495)
- "Fecal impaction can push on the bladder and change the angle of the ureter entering the bladder, causing reflux" — Jason Frischer (host_summary) [Ep 2 · 8:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=519)
- "In Kansas City, the Mitrofanoff goes at the umbilicus and the MACE or appendicostomy goes in the right lower quadrant" (clinical) [Ep 2 · 9:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=559)
- "Anatomically, the bladder is a midline structure and access through the umbilicus makes sense, while the cecum is in the right lower quadrant" — Marc Levitt (clinical) [Ep 2 · 9:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=569)
- "At Cincinnati Children's, 99% of Malones are placed in the umbilicus and almost all Mitrofanoffs are in the right lower quadrant with a tunnel channel through the rectus to prevent leakage" — Jason Frischer (clinical) [Ep 2 · 9:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=583)
- "The primary determinant of orifice location is where the appendix reaches and its blood supply" — Jason Frischer (clinical) [Ep 2 · 10:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=621)
- "Orifices should be properly separated and not matured until all teams have completed their work to avoid pulling on each other's mesentery" — Marc Levitt (clinical) [Ep 2 · 10:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=639)
- "The last steps of combined procedures should be maturing the Mitrofanoff, maturing the Malone, then closing the abdomen" — Jason Frischer (host_summary) [Ep 2 · 10:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=651)
- "Laxity of the pelvic floor and anal canal is a huge issue in spinal patients, especially when doing retrograde enemas" — Jason Frischer (clinical) [Ep 2 · 11:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=669)
- "Adding bisacodyl to the flush has shown good success in spinal patients" — Wendy (clinical) [Ep 2 · 11:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=691)
- "Spinal patients sometimes do better with smaller flush volumes because their colons empty at different rates" — Wendy (clinical) [Ep 2 · 11:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=695)
- "Having families or patients stand up at the end of their flush, move around, then sit back down helps evacuate more stool because things move through their colon differently" — Wendy (host_summary) [Ep 2 · 11:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=714)
- "Putting additional water volume into the enema balloon helps hold it in place so fluid doesn't leak around it in patients who cannot hold the enema like other children" (clinical) [Ep 2 · 12:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=736)
- "In spinal patients with poor pelvic floor muscles, using additional water in the balloon, larger balloon size, or different shapes like a cone helps with enema administration" — Amanda Jensen (host_summary) [Ep 2 · 12:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=768)

## Changelog
- Sep 7: 3 items added automatically

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